“Health exchange in the works - Denver Post” plus 1 more |
| Health exchange in the works - Denver Post Posted: 24 Dec 2010 05:10 AM PST What will the choices be, and who will shape them? Much is yet to be decided in Colorado. More than 500,000 Coloradans who lack health insurance will use a new state-run exchange to get generous subsidies and comparison shop for a health plan — that much is a given. What that consumer website — the centerpiece of national and state health care reform — will look like upon launch in 2014 is the next great task for medical and insurance leaders in Colorado. Will it be a bare-bones, three-choices- and-good-luck Web page? Utah is going that route. Or will Colorado take the activist route pioneered by Massachusetts and California, adding mandates for coverage, negotiating directly with insurers and carefully policing rates, complaints and care? Will insurance plans created by the state Medicaid office and Denver Health compete for customers alongside big names such as Kaiser, Anthem, Cigna or Rocky Mountain Health Plans? And even before that, who creates and operates the exchange that will guide billions of dollars in health spending? A state agency controlled by the governor? A private nonprofit? A quasi-governmental board where legislators, Cabinet secretaries and insurance interests will vie for appointments? Planners also fear the effects of a flood of new consumers on state computer systems already strained by rapid growth in Medicaid and food-assistance clients. With the potential for many Colorado employers also using the exchange if they find it practical, "the public should care," said University of Colorado Denver health-policy economist Adam Atherly. "It's fairly likely they'll be getting their health insurance from the exchange, even those with employer-based insurance." Experts believe the exchanges will move forward, even as conservative opponents fight the federal health care reform law in court. A federal judge in Virginia said mandates requiring all Americans to have insurance are illegal, but those provisions don't take effect until 2014, and other judges have ruled them legal. "There are two things we're trying to do: Bring costs down and cover more people," said Rocky Mountain Health Plans chief executive Steve ErkenBrack, one of many executives involved in the exchange discussions. "The devil is in the details." "The rules can look very different from state to state, depending on the values of that state," said Lorez Meinhold, Gov. Bill Ritter's director of health care reform implementation, who will keep the same position for Gov.-elect John Hickenlooper. As many as Kaiser The state exchanges are at the core of the controversial national Affordable Care Act passed in March. They are where up to 300,000 previously uninsured Coloradans must enter the system if they want to use generous federal subsidies for their premiums. Under the federal government's proposed "silver" or midlevel insurance plan design, for example, a family of four with $54,000 income would get a subsidy for 72 percent of the premium cost. Another 175,000 people or more could enter the Colorado exchange through small employers because federal law requires employers to begin offering insurance by 2014 or face a penalty. Even those employers already offering insurance may send employees to the exchange if high premiums qualify them for help. That's a half-million anticipated customers through one system, nearly as many as are currently enrolled in the giant Colorado HMO Kaiser Permanente. They will arrive expecting subsidies and needing education and information on everything from how a plan covers maternity to infection rates at local hospitals. A panel of government, nonprofit and private officials meets monthly to begin shaping the exchange. The 2011 legislature will need to pass a bill forming the exchange's governing structure and establishing the philosophical guidelines of what Colorado wants. If Colorado doesn't move ahead, federal rules will guide the exchange. A prime challenge for the exchange is to appeal at once to those who have never had insurance, savvy customers jaded by annual premium leaps and small businesses looking for help. "The foundation of reform is to build a stable platform with as few changes as possible, so people understand the rules and you can work on the big issues," ErkenBrack said. Those planning the exchange in the coming months will wrestle with vexing problems: • With Utah, California, Massachusetts and others forming their exchanges first, Colorado could pick and choose which models to follow. Decisions in other states also will determine whether Colorado allows out-of-state insurance plans to come in and sell their options across the state line, as many conservative reformers have long pushed for. Autism is an example of coverage dilemmas that will arise, ErkenBrack said. Federal regulators may be silent on whether autism treatments should be covered by the average consumer's insurance. An activist state such as California is more likely to cover it. Mississippi is much less likely to demand it. Can the insurer approved in Mississippi sell the same product to Colorado families? And if Colorado mandates more coverage than the federal minimums, it would need to find more money to subsidize those extras. May solve other issues Regulators also could use the exchange's clout to solve other problems. The Division of Insurance and consumer advocates, for example, were angry this fall when many Colorado carriers stopped selling child-only policies, often for unemployed families seeking basic protection for their children. Only two insurers still offer them. Regulators or the legislature could mandate that any carrier wanting into the exchange must add child policies. • State officials will need to find money to run the exchange within a few years. After the exchange is rolled out in 2013 and begins operation in 2014, federal money supporting administration disappears. Planners will need to find an ongoing source of revenue. That's likely to be a fee included in the consumers' premiums, paid either by the insurance company or the buyer. • Hospitals, clinics and doctors must gear up for a major new source of regular, paying customers. Many of those consumers currently use emergency rooms as their last-resort health care option. Denver Health received a grant to double its family-practice resident doctors from six to 12, in part to help serve an expected influx of paying patients. Studies show insured patients use services more often, rather than waiting for an emergency-room problem. Federally sponsored community clinics are likely to get a large percentage of that business and are expanding with $19 million in federal grants to three key centers in Colorado. • Exchange designers must answer whether an insurance plan hoping to compete on the exchange will need to offer health care to all corners of Colorado. Such a rule may seem to promote expanded rural coverage but could exclude desirable networks that limit themselves to major Front Range markets, such as Kaiser. State officials are not yet sure whether they will need to apply for federal waivers from the new law to allow the more piecemeal coverage plans. All decisions watched Pronouncements from federal regulators, court decisions and choices made by other states all will be watched by Colorado interests. "It's a pretty big continuum here, and we've got decisions to make," said Joan Henneberry, director of the state Health Care Policy and Finance Department, which already administers Medicaid and subsidized child-insurance plans. The Republican takeover of Colorado's House, while Democrats still control the Senate and governor's office, may add to tensions over costs and regulation. But Colorado bipartisanship on health care has worked in the past, most recently with the Blue Ribbon Commission that helped push expansion of Colorado Medicaid and CHP+ child coverage, said Leo Tokar, senior vice president of the private benefits broker Lockton Cos. "Now that we have one house red and the other house blue, we have the potential to have some very polarizing discussions," Tokar said. But the commission's highly influential recommendations passed on a 20-2 vote, he noted. "I'm hoping we lean more toward a more efficient marketplace rather than a political agenda." Even with the state and federal expansion over the next few years, more than 250,000 Coloradans will lack insurance, estimates the Colorado Health Institute. But health officials would consider that a tremendous improvement over the 800,000 without a health policy before major reform began in 2009. "Without the exchange, we can't go much further with our public programs in Colorado," Henneberry said. Michael Booth: 303-954-1686 or mbooth@denverpost.com This entry passed through the Full-Text RSS service — if this is your content and you're reading it on someone else's site, please read our FAQ page at fivefilters.org/content-only/faq.php This posting includes an audio/video/photo media file: Download Now |
| Health insurers may have to justify large premium hikes - Los Angeles Times Posted: 21 Dec 2010 04:27 PM PST Reporting from Washington — Moving to restrain skyrocketing health insurance premiums, the Obama administration is proposing rules requiring insurers to justify increases of more than 10% a year in 2011.At the same time, administration officials plan to step up federal review of premiums if state regulators cannot adequately protect consumers, a move cheered by many leading consumer advocates. The increased oversight comes as consumers nationwide struggle with rate hikes that have exceeded 30% in some places, even as insurance industry profits have swelled. In the lead-up to passage of the new law, the soaring rates fueled calls to give state and federal regulators more power to scrutinize premiums and even deny increases that appear unjustified. Only some states currently have such authority. The draft regulations unveiled Tuesday would not give state or federal officials the ability to deny rate hikes. Instead, the administration is relying on state regulators to scrutinize proposed hikes and to assess if they are justified by increases in the cost of care or other factors. Insurers whose rate increases are deemed unreasonable would be required to provide written justifications that would be posted on the federal government's new health website, http://www.healthcare.gov. "Ultimately, we know that the bright light of sunshine convinces more insurers to think twice and check their math before submitting large rate hikes," Secretary of Health and Human Services Kathleen Sebelius said Tuesday in announcing the proposed regulation, authorized by the new healthcare law. "This is our latest step to put consumers back in charge of their own healthcare." Insurance companies have said their headline-grabbing rate increases are being driven by the rising cost of healthcare, an assertion that the industry's senior Washington lobbyist reiterated Tuesday. Karen Ignagni, head of America's Health Insurance Plans, criticized the 10% threshold as unrealistic. "It does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage," she said. Insurers have fiercely resisted increased scrutiny of their rate setting at the state and federal level. Consumer groups, in contrast, largely applauded the additional oversight, which Families USA Executive Director Ron Pollack called "a very helpful and reasonable first step" to reining in rates. Under the new healthcare law, states retain primary responsibility for policing the insurance industry. The federal Department of Health and Human Services has made grants to 46 states to help them increase oversight. If states do not have the capacity to review rates, however, the federal department would step in to conduct the review under the proposed new rules. "What they try to do is to provide a backstop behind states," Rhode Island Health Insurance Commissioner Christopher Koller said Tuesday. The administration has estimated that about half of proposed rate hikes for plans serving people who buy insurance on their own could be subject to review. A slightly smaller share of increases in plans purchased by small businesses are expected to trigger review. Plans serving large employers will not be subject to the additional review. After 2011, federal officials plan to develop new state-by-state criteria for assessing rate increases. That could allow bigger rate hikes in some states and lower increases in others. This entry passed through the Full-Text RSS service — if this is your content and you're reading it on someone else's site, please read our FAQ page at fivefilters.org/content-only/faq.php This posting includes an audio/video/photo media file: Download Now |
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